1000 Section - Transcranial Focused Ultrasound Stimulation for the Treatment of Pediatric Disorders of Consciousness: The First Case Report

The patient was a 6-year-old girl who was diagnosed with influenza A virus-associated acute necrotizing encephalopathy. She was admitted to the hospital with over two months of impaired consciousness.

Case Description:

Low-Intensity Transcranial Focused Ultrasound (LIFU)regimen consisted of 20-minute sessions administered three times per week. We target the left thalamus under neuroimaging navigation. fMRI data were acquired at both baseline and after intervention session. Consciousness levels were assessed using the PGCS, CRS-R and ADL scale.

After 12 times intervention, PGCS score improved from 7 to 15, and CRS-R score increased from 5 to 20. Using the posterior cingulate cortex as the seed point, the results demonstrated that LIFU increased functional connectivity between the posterior cingulate cortex and the bilateral anterior-middle cingulate cortex, left dorsomedial prefrontal cortex, and bilateral supplementary motor area. Conversely, it decreased functional connectivity with the bilateral temporal lobes, bilateral parietal lobes, and left superior frontal gyrus.

Discussions:

At the 3-month follow-up after the intervention, we observed a continued improvement in the patient's neurological function. In this pediatric case, a decrease in FC was noted in the bilateral temporoparietal junction—a key node of the DMN. This observed reduction may be attributed to the patient's regained consciousness, which facilitated the re-emergence of the anti-correlated pattern of activity between the executive and default mode networks. Consequently, the FC between the executive and salience networks was notably enhanced. This case illustrates the dynamic interplay between the default mode network and the executive control networks during recovery from a disorder of consciousness.

Conclusions:

Focused ultrasound therapy demonstrates a favorable safety profile and holds promise as a potential treatment for pediatric disorders of consciousness by remodeling neural networks, warranting further investigation.